Safety and Efficacy of Hybrid Angiography in Chronic Lower Extremity Ischemia Patients at Risk of Contrast-Induced Acute Kidney Injury

2021 ◽  
pp. 153857442110559
Author(s):  
Ashraf G. Taha ◽  
Mahmoud Saleh ◽  
Haitham Ali
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Lower Extremity ◽  
Contrast Medium ◽  
Kidney Injury ◽  
Technical Success ◽  
Endovascular Interventions ◽  
Lower Extremity Ischemia ◽  
The Mean ◽  
Extremity Ischemia

Aim The aim of the study was to assess the feasibility and safety of hybrid angiography consisting of carbon dioxide (CO2) angiography supplemented by small doses of iodinated contrast medium (ICM) in the endovascular treatment of chronic limb threatening ischemia (CLTI) patients with pre-existing chronic kidney disease (CKD). Patients and Methods This prospective study comprised all non–dialysis-dependent CKD patients presenting for endovascular management of CLTI. All endovascular interventions were done using CO2 as a contrast medium whether alone or supplemented by ICM (hybrid angiography) to treat unilateral arterial steno-occlusive lesions of iliac, femoropopliteal, or BTK arteries. Study outcomes included feasibility of the device, technical success, and freedom from contrast-induced acute kidney injury (CI-AKI), renal replacement therapy, and CO2 angiography-related complications. Results A total of 206 CKD patients underwent endovascular intervention using CO2 only as a contrast medium (159 patients, 77.2%), or hybrid CO2-ICM angiography (47 patients, 22.8%). The overall technical success was 95.6%. Patients were followed up for a mean period of 17.9 ± 4.6 months. The mean volumes of CO2, and ICM consumption were 200.7 ± 95.1 mL, and 11.8 ± 4.4 mL, respectively. The mean procedural, and fluoroscopy times were 95.6 ± 12.5 and 49.5 ± 10.8 minutes, respectively. BTK lesions were significantly associated with the need for hybrid angiography ( P = <.0001). The mean pre- and postoperative serum creatinine levels were comparable ( P = .08). Two patients (4.3%) showed transient manifestations of CI-AKI, but neither required renal replacement therapy. No statistically significant differences were encountered between the two study groups regarding procedure outcomes. Conclusion Hybrid CO2-ICM angiography is safe, feasible, effective, and a fairly simple alternative during endovascular interventions to treat chronic lower extremity ischemia. Using supplemental small volumes of ICM to overcome the suboptimal images generated by CO2 alone does not jeopardize the renal functions in CKD patients.

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

scholarly journals Contrast-induced acute kidney injury in a planned endovascular interventions on the coronary arteries.

2018 ◽  
Vol 95 (12) ◽  
pp. 1086-1093 ◽  
Author(s):  
Elena O. Vershinina ◽  
A. N. Repin
Keyword(s):  
Acute Kidney Injury ◽  
Contrast Medium ◽  
Coronary Arteries ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Puncture Site ◽  
Endovascular Interventions ◽  
Kaplan Meier ◽  
Stable Coronary Heart Disease ◽  
History Of

Was performed a retrospective analysis of the frequency of contrast-induced acute kidney injury (CI-AKI) after the elective endovascular interventions on the coronary arteries in patients with stable coronary heart disease (CAD). CI-AKI was found in 23 patients (15,5%). Patients with CI-AKI initially significantly more likely to suffer chronic kidney disease (CKD), had higher erythrocyte sedimentation rate (ESR) before coronary intervention, received a significantly larger dose of the contrast medium, determines the ratio of the volume of the entered contrast medium to the glomerular filtration rate (VC/GFR). Predictors of CI-AKI, associated with the characteristics of patients are history of CKD (OR = 9,2; 95% CI 2,89-29,25; p <0,001) and COPD (OR = 4,07; 95% CI 1,23-13,5; p = 0,015), increased ESR before PCI ≥11,5 mm/h (AUC = 0,677; 95% CI 0,539-0,815; p = 0,025). Predictors of CI-AKI, associated with the conduct of the PCI procedure, are the ratio VC/GFR≥3,25 (AUC=0,633; 95% CI 0,505-0,762; р=0,042) and complications of arterial puncture site (OR = 1,23; 95% CI 1,13-1,33, p = 0,025). According to the analysis of Kaplan-Meier probability of overall survival and survival without fatal cardiovascular events in 7 years after the index PCI was significantly higher in the group of patients without CI-AKI.

Extended Sessions of Polymyxin-B Immobilized Fiber Column Hemoperfusion Ameliorate Renal Outcome and Mortality in Septic Shock with Acute Kidney Injury

2018 ◽  
Vol 46 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Hiroshi Maekawa ◽  
Kousuke Negishi
Keyword(s):  
Blood Pressure ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Renal Outcome ◽  
Control Methods ◽  
The Mean

Background/Aims: Polymyxin-B (PMX) treatment has been reported to decrease mortality in patients with septic shock and acute kidney injury (AKI). In this study, we aimed to evaluate whether extended sessions of PMX (Ext-PMX) immobilized fiber column hemoperfusion ameliorate clinical outcomes in patients complicated with septic shock and AKI without surgical control. Methods: Twenty-two patients with nonsurgical septic shock and AKI who received PMX were included. They were divided according to the duration of PMX treatment: Ext-PMX and standard PMX (Std-PMX). Results: The mean blood pressure increased and inotrope requirement decreased within 24 h after PMX initiation. The median value of predicted mortality was 52.5%, and the ­28-day mortalities in the Ext-PMX and Std-PMX groups were 44.4 and 75% respectively. Renal replacement therapy (RRT) was also initiated in 17 patients, and renal insufficiency was recovered. Conclusion: Ext-PMX combined with RRT improved clinical outcomes in patients with nonsurgical septic shock and AKI.

scholarly journals Intermittent hemodialysis for patients with acute kidney injury (AKI): Outcome in a tertiary level hospital

2018 ◽  
Vol 17 (2) ◽  
pp. 25
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

<p><strong>INTRODUCTION:</strong> Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.</p><p><strong>METHODS: </strong>This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.</p><p><strong>RESULTS: </strong>Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.</p><p><strong>CONCLUSION: </strong>UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.</p>

Direct kidney injury or lower extremity ischemia induced indirect kidney injury: Which one is more harmful for kidneys?

Vascular ◽  
2020 ◽  
pp. 170853812095996
Author(s):  
Bortecin Eygi ◽  
Orhan Gokalp ◽  
Muge Kiray ◽  
Sahin Iscan ◽  
Gamze Gokalp ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Ischemia Reperfusion ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Control Group ◽  
Significant Difference ◽  
Lower Extremity Ischemia ◽  
Group 3 ◽  
Group 2 ◽  
Extremity Ischemia

Objectives The aim of this study was to investigate and compare the severity of kidney damage following lower limb ischemia–reperfusion and direct kidney ischemia–reperfusion. Methods Thirty Sprague Dawley male rats were randomly divided into three groups; lower extremity ischemia–reperfusion group (Group 2), renal ischemia–reperfusion group (Group 3) and control (anesthesia and median laparotomy only) (Group 1). In group 3, 1-h ischemia was performed on the kidney and in group 2, 1-h ischemia was performed on the left lower extremity. This procedure was followed by reperfusion for 24 h. Renal tissues were removed after the reperfusion period and the groups were evaluated for glutathioneperoxidase activity, malondialdehyde and GSH levels, and furthermore, their histolopathological scores were calculated. Results Renal malondialdehyde levels were significantly higher in Group 2 and Group 3 than they were in the Control group. There was no significant difference in renal malondialdehyde levels between Group 2 and Group 3. Kidney glutathione (GSH) levels were statistically lower in Group 2 and Group 3 than in the Control group. No statistically significant difference was found between Group 2 and Group 3 regarding their GSH levels. In histological evaluation, there was no statistically significant difference between Group 2 and Group 3 in terms of kidney damage score. Conclusions This study has identified that lower extremity ischemia induces remote kidney damage with similar features to kidney injury, occurring after direct kidney ischemia–reperfusion.

Percutaneous Treatment of Superficial Femoral Artery Stenosis Secondary to Radiation Arteritis

2016 ◽  
Vol 82 (11) ◽  
pp. 1098-1100 ◽  
Author(s):  
Hao D. Pham ◽  
Melissa G. Prather ◽  
Daniel S. Rush
Keyword(s):  
Lower Extremity ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Percutaneous Treatment ◽  
Endovascular Technique ◽  
Endovascular Interventions ◽  
Lower Extremity Ischemia ◽  
Peripheral Arterial ◽  
Remote Radiation ◽  
Extremity Ischemia

Radiation arteritis is a rare cause of lower extremity peripheral arterial occlusive disease, and has been traditionally treated with open interventions. There have been only a few reported cases of endovascular interventions for this disease. Previous reports described endovascular treatment in the iliac and common femoral regions, but intervention in the superficial femoral artery have not been described. Described here is a case of acute lower extremity ischemia caused by remote radiation arteritis of the superficial femoral artery, which was successfully treated by percutaneous endovascular technique.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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